{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T01:55:15Z","timestamp":1774576515379,"version":"3.50.1"},"reference-count":11,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["IJU Case Reports"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cytokine release syndrome (CRS) is a rare immune\u2010related adverse event of immune checkpoint inhibitors (ICIs). At present, its association with avelumab\u2013axitinib therapy for renal cell carcinoma (RCC) has yet to be reported. Differentiating early CRS from an infusion\u2010related reaction (IRR) is clinically challenging, particularly in the context of concurrent coronavirus disease (COVID\u201019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 76\u2010year\u2010old woman with recurrent RCC developed chills, hypotension requiring norepinephrine, and hypoxemia within hours of her first avelumab infusion. Despite IRR\u2010directed therapy, the patient's condition worsened. Laboratory evaluation revealed markedly elevated Interleukin\u20106 with normal C\u2010reactive protein, elevated procalcitonin levels, and negative cultures, supporting cytokine\u2010driven inflammation. COVID\u201019 was detected and the clinical trajectory suggested CRS amplification. The patient was successfully treated with corticosteroids and tocilizumab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first report of CRS associated with avelumab\u2013axitinib therapy in RCC and highlights the importance of early recognition and distinction from IRR, especially when COVID\u201019 coexists.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/iju5.70152","type":"journal-article","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T03:40:31Z","timestamp":1771040431000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Case of Cytokine Release Syndrome Induced by Avelumab and Axitinib Combination Therapy for Metastatic Renal Cell Carcinoma"],"prefix":"10.1002","volume":"9","author":[{"given":"Rio","family":"Shibata","sequence":"first","affiliation":[{"name":"Department of Urology Fujisawa City Hospital  Fujisawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4945-7023","authenticated-orcid":false,"given":"Taku","family":"Mochizuki","sequence":"additional","affiliation":[{"name":"Department of Urology Fujisawa City Hospital  Fujisawa Japan"},{"name":"Department of Urology and Renal Transplantation Yokohama City University Medical Center  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7049-3379","authenticated-orcid":false,"given":"Takashi","family":"Kawahara","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation Yokohama City University Medical Center  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoharu","family":"Morikawa","sequence":"additional","affiliation":[{"name":"Department of Urology Fujisawa City Hospital  Fujisawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirokazu","family":"Kiuchi","sequence":"additional","affiliation":[{"name":"Department of Urology Fujisawa City Hospital  Fujisawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Hanai","sequence":"additional","affiliation":[{"name":"Department of Urology Fujisawa City Hospital  Fujisawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1499-546X","authenticated-orcid":false,"given":"Jun\u2010ichi","family":"Teranishi","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation Yokohama City University Medical Center  Yokohama 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